Mother's knowledge on prevention of mother-to-child transmission of HIV, Ethiopia
Alemu, Yihun Mulugeta; Habtewold, Tesfa Dejenie; Alemu, Sisay Mulugeta
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10.1371/journal.pone.0203043
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Alemu, Y. M., Habtewold, T. D., & Alemu, S. M. (2018). Mother's knowledge on prevention of mother-to-child transmission of HIV, Ethiopia: A cross sectional study. PLoS ONE, 13(9), [0203043].
https://doi.org/10.1371/journal.pone.0203043
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Mother’s knowledge on prevention of
mother-to-child transmission of HIV, Ethiopia: A cross
sectional study
Yihun Mulugeta Alemu1*, Tesfa Dejenie Habtewold2, Sisay Mulugeta Alemu3
1 School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia, 2 Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen,
The Netherlands, 3 International Medical Corps, Mental Health and Psychosocial Support Program, Dollo Ado Refugee Camp, Dollo Ado, Ethiopia
*yihun.mulugeta@yahoo.com
Abstract
Objective
To identify proportion of and factors for comprehensive knowledge on prevention of mother-to-child transmission of HIV in pregnant women attending antenatal care in Northern Ethiopia.
Methods
A total of 416 pregnant women were interviewed between October 2012 and May 2013. Logistic regression analysis was used to identify factors for comprehensive knowledge on prevention of mother-to-child transmission of HIV.
Results
The proportion of pregnant women, who have comprehensive knowledge on prevention of mother-to-child transmission of HIV, was 52%. The odds of having comprehensive knowl-edge on prevention of mother-to-child transmission of HIV were higher among pregnant women who were younger (16 to 24 years old) (Adjusted Odds Ratio (AOR) = 2.95; 95%CI: 1.20, 7.26), urban residents (AOR = 2.45; 95%CI: 1.39, 4.32), attending secondary educa-tion and above (AOR = 4.43; 95%CI: 2.40, 8.20), employed (AOR = 4.99;95%CI: 2.45, 10.16), have five children or more (AOR = 9.34; 95%CI:3.78, 23.07), have favored attitude towards HIV positive living (AOR = 2.53; 95%CI: 1.43, 4.44) and have perceived susceptibil-ity to HIV (AOR = 10.72; 95%CI: 3.90, 29.39).
Conclusion
The proportion of women who have comprehensive knowledge on prevention of mother-to-child transmission of HIV in this study setting was low. Measures which will escalate moth-er’s knowledge on prevention of mother-to-child transmission of HIV should be emphasized. Efforts to improve mother’s knowledge on prevention of mother-to-child transmission of HIV should target women who were older age (>= 35years), rural residents, unemployed, not a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS
Citation: Alemu YM, Habtewold TD, Alemu SM
(2018) Mother’s knowledge on prevention of mother-to-child transmission of HIV, Ethiopia: A cross sectional study. PLoS ONE 13(9): e0203043.
https://doi.org/10.1371/journal.pone.0203043
Editor: Zelalem T. Haile, Ohio University Heritage
College of Osteopathic Medicine, UNITED STATES
Received: July 12, 2017 Accepted: August 14, 2018 Published: September 11, 2018
Copyright:© 2018 Alemu et al. This is an open access article distributed under the terms of the
Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability Statement: All relevant data are
within the paper and its Supporting Information files.
Funding: The authors received no specific funding
for this work.
Competing interests: The authors have declared
attending formal education, primigravids, have no favored attitude towards HIV positive liv-ing and have not perceived susceptibility to HIV.
Background
Globally, significant numbers of people are living with HIV. More than 90 percent of new pediatric HIV infections are in sub-Saharan Africa [1]. In Ethiopia, an enormous number of children acquires HIV infection every year [2]. Mother–to–child transmission (MTCT) is the most common means of acquiring pediatric HIV infection since more than 90% of new HIV infection among children is through mother-to-child transmission. Without any inter-vention measures to prevent the transmission, the risk of MTCT ranges from 20% to 40%. However, mother-to-child transmission can be reduced to less than 2% in non–breastfeed-ing populations. In breast feednon–breastfeed-ing populations, the transmission can be reduced less than 5% with effective interventions during the periods of pregnancy, labor, delivery and breast-feeding [3].
Prevention of mother-to-child transmission (PMTCT) is one of the fundamental approaches to control HIV epidemic [1]. In early 2013, Ethiopia launched option B+ imple-mentation; i.e. all HIV infected pregnant women receive triple ARV (anti-retro viral) drugs without an initial CD4 testing [4]. To control the risk of MTCT of HIV, World Health Organi-zation has launched a program as virtual elimination of pediatric HIV. Four-pronged
approaches are incorporated as components of virtual elimination of pediatrics’ HIV. The approaches include primary prevention of HIV infection among women of childbearing age; preventing unintended pregnancies among women living with HIV; preventing HIV transmis-sion from a woman living with HIV to her infant and providing appropriate treatment, care and support to mothers living with HIV, their children and families [3]. For implementing prevention of mother-to-child transmission of HIV, one of the major problems is poor aware-ness and knowledge of the people about MTCT and PMTCT. Particularly, mother’s knowledge on PMTCT plays significant roles to realize preventive measures and to utilize the service [5].
Mother’s knowledge on prevention of mother-to-child transmission of HIV is essential in order to use available prevention options [6]. Women, who have adequate knowledge on HIV prevention, protect themselves, their husband and their children from HIV infection and are more likely to undergo HIV testing than women who do not have adequate knowledge on HIV [7]. On the other hand, women, who do not realize mother-to-child transmission of HIV and its prevention, have limited uptake of PMTCT services [8]. Regardless of widespread extension of PMTCT services, women’s knowledge on PMTCT is not satisfactory [9,10]. Inves-tigating the proportion and predictors for mother’s knowledge on prevention of mother-to-child transmission of HIV in resource limited settings have many benefits. It is a critical requirement to enhance mother’s knowledge on PMTCT. The investigation will also help to escalate utilizations of PMTCT services and it will ultimately be used to prevent and control transmission of HIV.
Previous studies have identified factors for mother’s knowledge on prevention of mother-to-child transmission of HIV [11–16]. However, different levels of mother’s knowledge on PMTCT were observed [17–20]. Contributions of factors for mother’s knowledge on PMTCT vary in settings of different populations [19–25]. We aim to identify proportion of and factors for comprehensive knowledge on prevention of mother-to-child transmission of HIV among pregnant women in Northern Ethiopia.
Methods
Study design and study settings
We conducted a facility based cross sectional study from October 2012 to May 2013 among pregnant women attending antenatal care in East Gojjam, Northern Ethiopia. In Northeast Gojjam Zone, 18 governmental health institutions are providing primary healthcare. Antenatal care service is provided in all primary healthcare centers. All mothers, who come for antenatal care, are linked to integrated PMTCT services [6]. Nurses, Midwifes and Health Officers are providing counselling and other four-pronged PMTCT services. Four governmental health institutions in the four districts were included (Motta, Gedieweyne, Debrewerk and Bichena).
Sample size estimation
Sample size was estimated using a single population proportion estimation formula and calcu-lated by using Epi-info 7 with 50% proportion, 5% of absolute precision, 95% confidence inter-val and non-response rate of 10%. The calculated overall sample size was 422. The sample size was calculated for different objectives. We took the largest estimated sample.
Sampling procedures
From 18 primary healthcare centers in Northeast Gojjam Zone, four primary healthcare cen-ters (Motta, Gendowin, Bitchena and Debrewerk) were selected by using lottery method and therefore included in the study. Pregnant women, who were attending the first antenatal care visit of their current pregnancies, were recruited. Systematic random sampling with sampling interval of three was used to select pregnant women from each health institution.
Data collection and analysis
Questionnaires were first prepared in English. It was then translated to Amharic and back translated to English. Pretest was conducted for consistency and ease of understanding. The study questionnaire was pretested in similar settings to the study area for two times. Firstly, pretest was conducted at Bahir Dar Zuria Werda primary healthcare center, West Gojjam Zone, among 20 pregnant women attending the first antenatal care of their current pregnancy; in this case, the questionnaire was validated for easy of communication. Vague words, phrases and sentences were corrected. Secondly, after the first pretest, study questionnaire was re-tested in Meray Woreda primary healthcare center, West Gojjam Zone, in 20 pregnant women attending the first antenatal care of their first pregnancy to endorse consistency of understand-ing among respondents; almost all respondents fully understand the questions. The final ver-sion of survey questionnaire was used to collect the actual data.
Data were collected from pregnant women during their first antenatal care visit. Trained nurses conducted face to face interviews with study participants by using study questionnaires. Data were collected to assess comprehensive knowledge on prevention of mother-to-child transmission of HIV and its associated factors (age, education, residence, employment, per-ceived susceptibility to HIV and attitude to HIV positive living).
Data were entered into Epi info 7 and analysis was done by using STATA 12. Frequencies and proportions were used to describe the study subjects in relation to the studied variables. Logistic regression model was used to examine the relation between explanatory variables and comprehensive knowledge on prevention of mother-to-child transmission of HIV. Bi-variable logistic regression models were fitted for all explanatory variables. Odds ratio with 95% confi-dence interval and p-value were used to measure strength of association and to identify statisti-cal significance of results. Identification of confounding variables by using logistic regression
model was used; predictor such as health institution and other covariates were adjusted for confounding. P-value less than 0.2 was used as a cutoff point to include explanatory variables from bi-variable models into a multivariable model. In this data set all explanatory variables that were fitted in the bi-variable model were fitted to a multivariable logistic regression model.
The Hosmer Lemeshow test was applied and the fit of the model was checked: a poor fit of the model if the p value is < 0.05 and good fit if the p-value is > 0.05. In this study the model was adequately fitted the data and the p-value was 0.93. The clustered nature of the data was taken into account in the analysis; however, multilevel logistic regression model was not fitted. Hence, the ICC (intra-class correlation coefficient) estimate of these data was 0.006 indicating that only 0.6% of the variation is due to difference between health institutions. Most of the var-iations (99.4%) were explained by the lower level measures (pregnant women). As Intra-class correlation coefficient was less than 5–10%, hierarchical modeling is not required [26].
Operational definitions
Comprehensive knowledge of PMTCT. Pregnant women were classified as knowledge-able if the women knew at least one means mother-to-child transmission of HIV (during preg-nancy, delivery or breast feeding) and method of prevention from mother-to-child
transmission of HIV (antiretroviral therapy for the mother and for the baby).
Favorable attitude towards persons living with HIV. Defined as a woman who perceived that her husband or/ and other family member/s will care for her if her HIV test result is posi-tive. The following question was asked. If your result turns out to be positive, what would be the likely reaction to your husband or relatives? The possible answers were four; no one will believe the results; I will be thrown out of home; I will be physically violated/abused; or he/ they will start to care for me.
Perceived susceptibility to HIV. Pregnant women who perceive the risk of acquiring HIV infection. The following question was asked. Do you think, you have risk of acquiring HIV? The possible answer was Yes or No.
Ethical considerations
Ethics approval was received from Bahir Dar University College of Medicine and Health Sci-ence research and ethical review committee. Written permission to conduct the study was got-ten from each health institution involved in the study. In addition, informed writgot-ten consents were obtained from study participants whose age were 18 years and more. This study also included participants between 16 years of age and 18 years; therefore, written assents from the teenagers and written permissions from their parents were done. Since there were illiterate participants and parents, the data collectors informed participants and parents about informed consents and assents. Willingness to participate in the study and parental permission were confirmed by signing (finger print for those who can’t sign) on the informed consent sheet.
Results
Demographic and perceptions of study participants
A total of 416 pregnant mothers were included in the analysis. The mean age and Standard Deviation (SD) of study participants was 28.2 years (SD: 6.15 years).
Table 1presents frequency distribution of factors for comprehensive knowledge on
preven-tion of mother-to-child transmission of HIV. The majority of pregnant women (55%) came from rural area. More than half of study participants (54%) were not attended formal
education. Higher proportion of mothers (63%) didn’t have favored attitude towards HIV pos-itive living. Only 15% pregnant women have perceived their risk of acquiring HIV infection.
Proportion of comprehensive knowledge on prevention of mother-to-child
transmission of HIV
In this study 52% of pregnant women had comprehensive knowledge on prevention of mother-to-child transmission of HIV. Higher proportion of younger age (16 to 24 years) women (59%) had comprehensive knowledge on prevention of mother-to-child transmission of HIV. Similarly, majority of women (85%), who perceived their risk of acquiring HIV infec-tion, had comprehensive knowledge on prevention of mother-to-child transmission of HIV.
Table 2shows factors for comprehensive knowledge on prevention of mother-to-child
transmission of HIV. Younger age (16 to 24 years old) (AOR = 2.95; 95%CI: 1.20, 7.26) was an
Table 1. Study variables for comprehensive knowledge of mother-to-child transmission of HIV in pregnant women attending antenatal care in East Gojjam, North-ern Ethiopia, 2013.
Variables No CKPMTCT n (%) Have CKPMTCT n (%) Total (%)
Health Institution’s site
Motta 86 (48.3%) 92(51.7%) 178(42%) Gndweyene 35 (47.9%) 38(52.1%) 73(17.6%) Debrewerke 37(48.1) 40(51.9) 77(18.5%) Bichena 42 (47.7) 46(52.3) 88(21.3%) Age 16–24 50(41) 72(59) 122(29) 25–29 57(43) 76(57) 133(32) 30–34 40(46) 47(54) 87(21) > = 35 53(71) 21(29) 74(18) Residence Rural 146(64) 83(36) 229(55) Urban 54(29) 133(71) 187(45) Education No formal education 153(69) 70(32) 223(54) Primary education 10(26) 28(74) 38(10)
Secondary and above 37(24) 118(50) 155(37)
Occupation Unemployed 184(62) 115(38) 299(72) Employed 16(14) 101 (86) 117(38) Parity 0 89(74.2) 31(25.58) 120(29) 1–4 98(45.2) 119(54.8) 217(52) 5 13(16.5) 66(83.5) 79(19)
Favored attitude towards HIV positive living
Yes 44(28) 115(72) 155 (37)
No 156(61) 101(39) 266 (63)
Perceived susceptibility to HIV
Yes 9(15) 53(85) 62(15)
No 191(64) 163(36) 354(85)
CKPMTCT = comprehensive knowledge on mother-to-child transmission of HIV
independent factor for increased comprehensive knowledge on prevention of mother-to-child transmission of HIV compared with women older than 35 years. Urban residency (AOR = 2.45; 95%CI: 1.39, 4.32) was an independent factor for increased comprehensive knowledge on prevention of mother-to-child transmission of HIV. Similarly, women who attended second-ary education and above (AOR = 4.39; 95%CI: 2.), were more likely to have higher comprehen-sive knowledge on prevention of mother-to-child transmission of HIV than women who do not attend formal education. Employed women (AOR = 4.99;95%CI: 2.45, 10.16) were more likely to have increased comprehensive knowledge on prevention on mother-to-child trans-mission of HIV than unemployed women. Likewise, having five or more children (AOR = 9.34; 95%CI:3.78, 23.07), favored attitude towards HIV positive living (AOR = 9.34; 95% CI:3.78, 23.07) and perceived susceptibility to HIV (AOR = 11.72; 95%CI: 3.90, 29.39) were independently associated with increased comprehensive knowledge on prevention of mother to child transmission of HIV among pregnant women.
Discussion
This study described the proportion of mother’s knowledge on PMTCT. In addition, this study identified predictors for mother’s knowledge on PMTCT. The proportion of mothers, who do have comprehensive knowledge, was low. These findings have important impact on public health so as to prevent and control transmission of HIV particularly in lower income
Table 2. Factors independently associated with comprehensive knowledge on prevention of mother-to-child transmission of HIV in pregnant women, Northern Ethiopia, 2013.
Variable COR(95%CI) P-value AOR(95%CI) P-value
Age 16–24 3.63(1.95,6.76) < 0.001 2.95(1.20, 7.26) 0.018 25–29 3.36(1.92,6.20) < 0.001 2.49(1.06, 5.86) 0.036 30–34 2.96(1.53, 5.72) 0.001 3.18(1.24, 8.13) 0.016 > = 35 1 1 Residence Rural 1 1 Urban 4.33(2.86, 6.56) 2.45(1.39,4.32) 0.002 Education No formal education 1 1 Primary education 6.12(2.81, 13.29) < 0.001 3.35(1.32, 8.48) 0.0113 Secondary above 6.97(4.37, 11.09) < 0.001 4.43(2.40, 8.20) < 0.001 Occupation Unemployed 1 1 Employed 10.10(5.67, 17.97) < 0.001 4.99(2.45,10.16) < 0.001 Parity 0 1 1–4 3.48(2.13,5.68) < 0.001 2.69(1.36, 5.30) 0.004 5 14.57(7.08, 29.99) < 0.001 9.54(3.90, 23.32) < 0.001 HIV positive living
Favored attitude 4.03(2.63, 6.19) < 0.001 2.53(1.43,4.44) 0.001
Not favored attitude 1 1
Perceived susceptibility to HIV
Yes 6.9 (3.30, 14.41) < 0.001 11.72(3.9, 29.39) < 0.001
No 1 1
settings, where HIV overwhelm the already limited health system. The study findings should alert public health agencies since mother’s comprehensive knowledge on PMTCT is still unsat-isfactory. Furthermore, as this study was a preliminary assessment, researchers should explore other means that can potentially enhance mother’s knowledge on PMTCT.
In this research 52% of pregnant women had comprehensive knowledge on prevention of mother-to-child transmission of HIV. This finding is consistent with a study conducted in Tanzania which described the proportion of women, who have adequate knowledge of PMTCT, was 46% [21]. However, our finding was higher than a study conducted in Gambila region which showed that only 17% pregnant women knew prevention of mother-to-child transmission of HIV [27]. Variability of mother’s knowledge on prevention of mother-to-child transmission of HIV was observed among studies. The proportions of mother, who do have adequate knowledge on preventions of mother-to-child transmission of HIV, rang from 9% to 78% [17–19,27,28].The variations in proportions of mother’s knowledge among studies could be due to differences in study periods. Increased proportions of women, who have comprehen-sive knowledge on prevention of mother-to-child transmission of HIV, have observed in recent times. Furthermore, difference in source population may be linked with difference on factors that affect mother’s knowledge on preventions of mother-to-child transmission of HIV.
In our study, younger age was an independent factor for increased comprehensive knowl-edge on prevention of mother-to-child transmission of HIV. It was consistent with a research finding that showed older age women had lower level of knowledge on PMTCT [20]. This could be due to opportunities among younger women, who have better access to education, enable them to have more information sources such as newspaper and social media. In con-trast, a study conducted in Kenya showed that there was no statistically significant difference between knowledge of teenage pregnant women compared with older pregnant women [14]. This could be due to smaller sample size of the study conducted in Kenya that lower the power of the study to detect the association.
Similar to studies conducted in Tanzania and Sudan [15,16]. Our study identified that women, who live in urban area, were more likely to have knowledge on prevention of mother-to-child transmission of HIV compared with women who live in rural area. Most mothers, who live in rural area, had limited access to PMTCT service. Even if some women do have accesses to PMTCT services, their services utilization remains low. Being a rural resident was found to be a barrier for uptake of PMTCT services [22–24]. Therefore, knowledge of the mother on PMTCT could be affected by access and utilizations of the services. Mothers, who are attending PMTCT services, also obtain PMTCT knowledge and counseling [4]. Corre-spondingly, knowledge of the mother attributes to utilization of PMTCT services. Pregnant women, who do have comprehensive knowledge on prevention of mother-to-child transmis-sion, are more likely tested for HIV than women who do not have comprehensive knowledge on prevention of mother-to-child transmission of HIV [7].
Mothers in this study, who attended formal education, were more likely to have higher knowledge on prevention of mother-to-child transmission of HIV than mothers who do not attend formal education. Level of education is linked with understanding of HIV/AIDS trans-mission and its prevention. Populations, who attended formal education, have demonstrated adequate understanding of HIV transmission and its prevention [29]. Limited knowledge on PMTCT, on the other hand, was identified in pregnant women who had lower level of educa-tion [30]. Similarly, low level of educational was associated with deceased uptake of PMTCT services [25]. Missed opportunities of PMTCT in health facilities as well as in community engagement services were higher in pregnant women with low level of education [31]. Mater-nal knowledge about PMTCT could directly be affected by school training that enables
mothers to understand diseases transmission and its prevention. Educated mothers are privi-leged in accessing and utilizing PMTCT services that enhance mother’s knowledge on PMTCT [7].
This research finding revealed that unemployed women were less likely to have knowledge on prevention of mother-to-child transmission of HIV than employed women. Often, employed women are advantageous in terms of income and social networking than unem-ployed. Income-level of the mother is linked with the mother’s knowledge on preventions of mother-to-child transmission of HIV [32]. Acquiring of HIV related knowledge is associated with income-level in the way that higher income group have better access of information and services on PMTC [33,34]. Employed women are connected with higher income level; employment was coupled with access and use of favored social-networking. Employment enables women to have social links with groups who do have better information on HIV/ AIDS. Knowledge is shared within group members or among different groups. Among work-ing groups, interchange of ideas and learnwork-ing about health services were evidenced in various types of working environments [35–37].
Women who have good knowledge on HIV/AIDS such as adequate knowledge on antire-troviral therapy and on HIV positive living, are able to cope stigma, discrimination and stereo-type [37]. Likewise, favored attitude towards HIV positive living was independently associated with increased knowledge on prevention of mother-to-child transmission of HIV. Perceived susceptibility to HIV was associated with increase awareness of HIV services and higher utili-zations of health services. On the other hand, those who don’t have adequate knowledge on HIV believed that they don’t have the risk of acquiring HIV infection once they are married. Nevertheless, newly HIV infected pregnant women were identified among married couples in similar settings [38].
Limitations
Since this research was health institution based cross-sectional study, the data can’t be inferred to the general population. The findings can’t extrapolate to pregnant women who didn’t attend the health institutions. Since temporal relationship of outcome and exposure variables is hardly possible, this study does not establish causations. However, the multivariable analysis indicated strong associations between exposure and outcome variables; therefore, this study provides valuable information that will enhance mother’s knowledge on prevention of mother-to-child transmission of HIV.
Conclusion
Proportion of women, who have comprehensive knowledge on prevention of mother-to-child transmission of HIV in this study, was low. Measures, which will escalate mother’s knowledge on prevention of mother-to-child transmission of HIV, should be emphasized. Efforts to improve mother’s knowledge on prevention of mother-to-child transmission of HIV should target women who are older age (> = 35years), live in rural, unemployed, not attending formal education, primigravids, have no favored attitude towards HIV positive living and have not perceived susceptibility to HIV.
Supporting information
S1 File. This is the English version of study questionnaire. This is a copy of English Version Study questionnaire.
S2 File. This is the Amharic version of study questionnaire. This is a copy of Amharic Ver-sion Study questionnaire.
(DOCX)
S3 File. This is all relevant data of this study. This is the de-identified data. (XLSX)
Acknowledgments
The authors gratefully acknowledge data collectors and study participants involved in the study.
Author Contributions
Conceptualization: Yihun Mulugeta Alemu, Tesfa Dejenie Habtewold, Sisay Mulugeta Alemu.
Data curation: Yihun Mulugeta Alemu.
Formal analysis: Yihun Mulugeta Alemu, Tesfa Dejenie Habtewold, Sisay Mulugeta Alemu. Investigation: Sisay Mulugeta Alemu.
Methodology: Yihun Mulugeta Alemu, Sisay Mulugeta Alemu. Resources: Yihun Mulugeta Alemu.
Software: Yihun Mulugeta Alemu. Supervision: Yihun Mulugeta Alemu.
Validation: Yihun Mulugeta Alemu, Sisay Mulugeta Alemu. Visualization: Yihun Mulugeta Alemu.
Writing – original draft: Yihun Mulugeta Alemu, Tesfa Dejenie Habtewold, Sisay Mulugeta Alemu.
Writing – review & editing: Yihun Mulugeta Alemu, Tesfa Dejenie Habtewold, Sisay Mulu-geta Alemu.
References
1. USAID: Report on the global AIDS epidemic: USAID: 2016.
2. Central Statistical Agency (2014) HIV/AIDS Estimates and Projections in Ethiopia, 2011–2016. Central Stastistical Agenency, 2014.
3. World Health Organization (2017) Global guidance on criteria and processes for validation: Elimination of Mother-to-Child Transmission of HIV and Syphilis:; WHO: Geneva, Switzerland, 2017.
4. UNICEF (2014) Survival and Health; Ethiopia has lanuched option B+: Ethiopia, 2104.
5. Sama C-B, Feteh VF, Tindong M, Tanyi JT, Bihle NM, Angwafo FF. Prevalence of maternal HIV infec-tion and knowledge on mother–to–child transmission of HIV and its preveninfec-tion among antenatal care attendees in a rural area in northwest Cameroon. PloS one. 2017; 12:e0172102.https://doi.org/10. 1371/journal.pone.0172102PMID:28199373
6. Federal Ministry of Health Ethiopia (2011) Guidelines for prevention of mother to child transmission of HIV in Ethiopia. Ministry of Health, 2011.
7. Alemu YM, Ambaw F, Wilder-Smith A. Utilization of HIV testing services among pregnant mothers in low income primary care settings in northern Ethiopia: a cross sectional study. BMC Pregnancy and Childbirth. 2017; 17:199.https://doi.org/10.1186/s12884-017-1389-2PMID:28646888
9. Abiodun MO, Ijaiya MdA, Aboyeji PA. Awareness and knowledge of mother-to-child transmission of HIV among pregnant women. Journal of the National Medical Association. 2007; 99:758–63. PMID:
17668641
10. Orne-Gliemann J, Mukotekwa T, Perez F, Miller A, Sakarovitch C, Glenshaw M, et al. Improved knowl-edge and practices among end-users of mother-to-child transmission of HIV prevention services in rural Zimbabwe. Tropical medicine & international health: TM & IH. 2006; 11:341–9.
11. Veloso VG, Portela MC, Vasconcellos MT, Matzenbacher LA, Vasconcelos AL, Grinsztejn B, et al. HIV testing among pregnant women in Brazil: rates and predictors. Revista de saude publica. 2008; 42:859–67. PMID:18833385
12. Kominami M, Kawata K, Ali M, Meena H, Ushijima H. Factors determining prenatal HIV testing for pre-vention of mother to child transmission in Dar Es Salaam, Tanzania. Pediatrics international: official journal of the Japan Pediatric Society. 2007; 49:286–92.
13. Creek T, Ntumy R, Mazhani L, Moore J, Smith M, Han G, et al. Factors associated with low early uptake of a national program to prevent mother to child transmission of HIV (PMTCT): results of a survey of mothers and providers, Botswana, 2003. AIDS and behavior. 2009; 13:356–64.https://doi.org/10.
1007/s10461-007-9322-8PMID:17985228
14. Amoran OE, Salami OF, Oluwole FA. A comparative analysis of teenagers and older pregnant women in the utilization of prevention of mother to child transmission [PMTCT] services in, Western Nigeria. BMC international health and human rights. 2012; 12:13.https://doi.org/10.1186/1472-698X-12-13
PMID:22883969
15. Falnes EF, Tylleskar T, de Paoli MM, Manongi R, Engebretsen IM. Mothers’ knowledge and utilization of prevention of mother to child transmission services in northern Tanzania. Journal of the International AIDS Society. 2010; 13:36.https://doi.org/10.1186/1758-2652-13-36PMID:20840784
16. Mahmoud MM, Nasr AM, Gassmelseed DE, Abdalelhafiz MA, Elsheikh MA, Adam I. Knowledge and attitude toward HIV voluntary counseling and testing services among pregnant women attending an antenatal clinic in Sudan. Journal of medical virology. 2007; 79:469–73.https://doi.org/10.1002/jmv.
20850PMID:17385672
17. Omwega AM, Oguta TJ, Sehmi JK. Maternal knowledge on mother-to-child transmission of HIV and breastmilk alternatives for HIV positive mothers in Homa Bay District Hospital, Kenya. East Afr Med J. 2006; 83:610–8. PMID:17455450
18. Baiden F, Remes P, Baiden R, Williams J, Hodgson A, Boelaert M, et al. Voluntary counseling and HIV testing for pregnant women in the Kassena-Nankana district of northern Ghana: is couple counseling the way forward? AIDS Care. 2005; 17:648–57.https://doi.org/10.1080/09540120412331319688
PMID:16036251
19. Sama CB, Feteh VF, Tindong M, Tanyi JT, Bihle NM, Angwafo FF 3rd. Prevalence of maternal HIV infection and knowledge on mother-to-child transmission of HIV and its prevention among antenatal care attendees in a rural area in northwest Cameroon. PloS one. 2017; 12:e0172102.https://doi.org/ 10.1371/journal.pone.0172102PMID:28199373
20. Malaju MT, Alene GD. Determinant factors of pregnant mothers’ knowledge on mother to child transmis-sion of HIV and its prevention in Gondar town, North West Ethiopia. BMC Pregnancy Childbirth. 2012; 12:73.https://doi.org/10.1186/1471-2393-12-73PMID:22838392
21. Haile ZT, Teweldeberhan AK, Chertok IR. Correlates of women’s knowledge of mother-to-child trans-mission of HIV and its prevention in Tanzania: a population-based study. AIDS Care. 2016; 28:70–8.
https://doi.org/10.1080/09540121.2015.1062465PMID:26278589
22. Anigilaje EA, Ageda BR, Nweke NO. Barriers to uptake of prevention of mother-to-child transmission of HIV services among mothers of vertically infected HIV-seropositive infants in Makurdi, Nigeria. Patient preference and adherence. 2016; 10:57–72.https://doi.org/10.2147/PPA.S87228PMID:26869770 23. Murithi LK, Masho SW, Vanderbilt AA. Factors Enhancing Utilization of and Adherence to Prevention of
Mother-to-Child Transmission (PMTCT) Service in an Urban Setting in Kenya. AIDS and behavior. 2015; 19:645–54.https://doi.org/10.1007/s10461-014-0939-0PMID:25381562
24. Bajunirwe F, Muzoora M. Barriers to the implementation of programs for the prevention of mother-to-child transmission of HIV: a cross-sectional survey in rural and urban Uganda. AIDS Res Ther. 2005; 2:10.https://doi.org/10.1186/1742-6405-2-10PMID:16255776
25. Kinuthia J, Kiarie JN, Farquhar C, Richardson BA, Nduati R, Mbori-Ngacha D, et al. Uptake of preven-tion of mother to child transmission intervenpreven-tions in Kenya: health systems are more influential than stigma. Journal of the International AIDS Society. 2011; 14:61. https://doi.org/10.1186/1758-2652-14-61PMID:22204313
26. Kianoush FV, Masoomehni K. Application REML model and determining cut off of ICC by multi-level model based on Markov Chains simulation in health. Indian Journal of Fundamental and Applied Life Sciences. 2015; 5:1432–48.
27. Abtew S, Awoke W, Asrat A. Knowledge of pregnant women on mother-to-child transmission of HIV, its prevention, and associated factors in Assosa town, Northwest Ethiopia. HIV/AIDS (Auckland, NZ). 2016; 8:101–7.
28. Ashimi AO, Omole-Ohonsi A, Amole TG, Ugwa EA. Pregnant women’s knowledge and attitude to mother to child transmission of human immuno-deficiency virus in a rural community in Northwest Nige-ria. West African journal of medicine. 2014; 33:68–73. PMID:24872270
29. Nubed CK, Akoachere JF. Knowledge, attitudes and practices regarding HIV/AIDS among senior sec-ondary school students in Fako Division, South West Region, Cameroon. BMC Public Health. 2016; 16:847.https://doi.org/10.1186/s12889-016-3516-9PMID:27549185
30. Kipp W, Kabagambe G, Konde-Lule J. Low impact of a community-wide HIV testing and counseling pro-gram on sexual behavior in rural Uganda. AIDS Educ Prev. 2001; 13:279–89. PMID:11459363 31. Woldesenbet S, Jackson D, Lombard C, Dinh TH, Puren A, Sherman G, et al. Missed Opportunities
along the Prevention of Mother-to-Child Transmission Services Cascade in South Africa: Uptake, Deter-minants, and Attributable Risk (the SAPMTCTE). PloS one. 2015; 10:e0132425.https://doi.org/10. 1371/journal.pone.0132425PMID:26147598
32. Haffejee F, Ports KA, Mosavel M. Knowledge and attitudes about HIV infection and prevention of mother to child transmission of HIV in an urban, low income community in Durban, South Africa: Per-spectives of residents and health care volunteers. Health SA Gesondheid. 2016; 21:171–8.
33. Hasan AH, Hassan R, Khan ZR, Nuzhat E, Arefin U. Influence of socio-demographic factors on aware-ness of HIV/AIDS among Bangladeshi garment workers. SpringerPlus. 2013; 2:174.https://doi.org/10.
1186/2193-1801-2-174PMID:23710426
34. Qu B, Guo H, Sun G, Zuo T, Zhang Y, Li BY. HIV/AIDS Knowledge, Attitudes, and Behaviors of Con-struction Workers in China. International journal of biomedical science: IJBS. 2008; 4:192–5. PMID:
23675089
35. Calvo´-Armengol Antoni and Jackson Matthew O. 2004. "The Effects of Social Networks on Employment and Inequality." American Economic Review, 94(3): 426–454.
36. Ventola CL. Social Media and Health Care Professionals: Benefits, Risks, and Best Practices. Phar-macy and Therapeutics. 2014; 39:491–520. PMID:25083128
37. Adams MB, Kaplan B, Sobko HJ, Kuziemsky C, Ravvaz K, Koppel R. Learning from Colleagues about Healthcare IT Implementation and Optimization: Lessons from a Medical Informatics Listserv. Journal of Medical Systems. 2014; 39:157.https://doi.org/10.1007/s10916-014-0157-3PMID:25486893 38. Mpairwe H, Muhangi L, Namujju PB, Kisitu A, Tumusiime A, Muwanga M, et al. HIV risk perception and
prevalence in a program for prevention of mother-to-child HIV transmission: comparison of women who accept voluntary counseling and testing and those tested anonymously. Journal of acquired immune deficiency syndromes (1999). 2005; 39:354–8.
